Therese Hughes – We need to see more of the organizations that
represent people and that represent the underserved on the “partners”
list; it’s a matter of perception.

George Grob – The idea of identifying some “heavy hitters”
is that we need to select some, work with our contractors, and get the
Working Group’s agreement that staff would move ahead to go ahead
with an initiative. We have been talking with senior staff of Starbucks
as part of this activity; the business people who run the company have
expressed concern about both legal implications as well as practical
issues of their potential participation in a public outreach effort.

Catherine McLaughlin – I’ve been involved in reaching out
to the University of Michigan and the possibility of it providing a
venue for a community meeting that could also include reaching out to
many others among the “big 10” (public universities). The
advice I’ve heard is that we should try to do the webcast and
concentrated University of Michigan all on the same night so that you
can get media/press coverage. We could probably do this in April; we
need to give them a date.

Jonathan Ortmans – There’s a lot of room for creativity
here if everyone thinks about all the organizations that we each interact
with; this will enable us to take this project up to “scale.”

Joe Hansen – We need to figure out how to get the outreach going
more actively; right now we’re dead in the water. The press wants
to know about something controversial.

Jonathan Ortmans, Carolyn Lukensmeyer -- We need to grab media outlets
more effectively. It will help if we get a sufficient number of sites.

There was no dissent when the members were asked how they felt about
the idea of a breakfast event for partner organizations?

Connie Smith
Topic Covered: Media

Discussion

It was asked whether the Working Group should build on their experiences
and contacts in the local communities, laying out thematically the potential
stories, and develop op ed pieces and news articles—with some
support from the staff or contractors.

Brent James – We should distinguish between “givens,”
things that we should just assume that everyone would agree on: efficiency
and eliminating error. I’d recommend we make recommendations around
those but that we don’t engage the public in a conversation about
those. The givens are the things for which there is clear factual basis.
I don’t want to ask the public how to put together a data dictionary,
for example; some topics we need to say something about: IT, patient
safety, etc., but I don’t want to ask questions about them. But
there are other areas that I do want to ask the public about. Some things
are so obvious, that we shouldn’t have to ask about them. The
whole purpose of asking questions is to lead us to information that
leads us to recommendations. Some things are just internal, based on
the facts. Access is another story.

Dotty Bazos – Even around medical error, there are a series of
value laden issues that we might want to ask the public for their opinion.

Catherine McLaughlin – We can ask scaled or weighted questions
that will provide information to assist us in addressing the trade-offs.
We can ask how people would rank options; these are questions we probably
want to keep.

Joe Hansen, Frank Baumeister – We can’t really take any
questions off the table because part of the work is dialogue; everything
is open to public opinion; not everyone is aware of what others know
to be irrefutable fact.

Brent James – There are two ways of viewing health care reform:
inside-out and outside-in; fixing medical error is “inside-out.”
Since we can’t ask all the questions we’d like; we distinguish
items that are so self-evident that they don’t need questions.
But, we still address them in the recommendations.

Catherine McLaughlin – The community meeting topics need to deal
with all the topics but the questions could be selective.

George Grob – When we develop recommendations, we will need to
make sure they are compatible with the overall direction of input from
the public, not necessarily reflecting it down to the nth level of detail.

Catherine McLaughlin, Aaron Shirley, Therese Hughes – Why not
use the framework that is mandated in the Act as the way to organize
the way we structure the topics and the interim recommendations? Why
not organize the whole process around the four elements required in
the law? If we could agree that the original intent should be the focus.
Why reinvent the wheel? We have simple directions; why not use it?

Randy Johnson – We’ll go through each question and later
decide what the framework should be; and ask the staff to come back
with a recommendation as to what the framework should be.

The Working Group generally thought that the four elements in the law:
services, delivery, financing, and trade-offs, should be used as the
basis for organizing questions to the American people and for organizing
recommendations—until/unless subsequently changed.

The Working Group collaborated on changes to the document:

Topics of Interest to Working Group Members Washington,
DC, October 5, 2005 (see revised document).

George Grob – The discussion guide will include a broad presentation
of a variety of topics. The question is: what is the scope of the areas
to be addressed. When we’re done, we want answers to about 20
broad questions that will support the kinds of recommendations we come
out with.

Brent James – We need to come up with the technical things ourselves;
we need to use Mike Garland from Oregon. There are various ways to boil
down the long list of issues to a few.

Wrap Up On Discussion of Questions

George Grob – Discussions and recommendations will be operating
at a higher level of generality than the detailed discussion that has
taken place today. I suggest the staff convene with contractors and
Mike Garland and that we then go back and forth with you on a set of
questions. We’ll need to do fairly rapidly. We’ll share
with you by email and have a telephone call, likely to be a two hour
call, to discuss.

Richard Frank – Might it not make sense to organize the Working
Group around major areas for producing recommendations?

George Grob indicated that recommendations could include both short
and long term elements. The staff recommendation was that, to be credible,
the Working Group’s recommendations needed to be a blend of both
detailed and broad. We need a framework that will provide a way and
a set of principles to fix the whole system. The members engaged in
a general discussion concerning the level of detail that ought to be
reflected in the recommendations. Comments that were made included:
the recommendations ought to complement and acknowledge the work of
others. The unique contribution that the Working Group brings is that
they could reflect a profound and deep appreciation of what the American
people think about health care.

Catherine McLaughlin – We’ve been given a plan for what
we are to do: the four areas spelled out in the law.

Brent James – The IOM report, “Crossing the Quality Chasm,”
ought to be heavily relied on and referenced and the recommendations
in that paper should be cited. It is used commonly and it has generated
more work by others.

Pat Maryland – Hearing from the public is what is unique about
what we’re doing here and what distinguishes this activity from
all the reports that have been done by experts. If we can link to other
studies that have been done, that will give us credibility.

The Working Group concluded that it would work toward a consensus set
of interim recommendations with no “poison pills.” The results
of the effort would be broad-based, incremental, concrete recommendations,
reflecting what was heard from the public, and contain both short and
long term steps (e.g., a ‘plan’). The “texture”
of the recommendations to the President and the Congress should somehow
reflect the fact that it is from the American people. The Working Group
should seek and consider information from a wide variety of sources.
The Working Group will need to be careful to consider the information
received from the point of view of how representative it is. As in Oregon,
the Working Group goes to the public for its values (its heart) and
then translates those values into a practical way. The members of the
Working Group will keep each other honest and will be checking with
others who will help keep it honest.

Should Any Topics Be “Off the Table?”

The members agreed they would take no potential topics or health issues
“off the table” for consideration for possible recommendations.

What Would be the Venue for Recommendations?

Would the recommendations be for the federal government to take or
also non-legislative recommendations or for others as well?

There would be a menu of recommendations for Congress and the federal
government;

But it should not stop there.

Topics for Staff Briefings at the December and January Working Group
Meetings

What topics should be presented to the Working Group? The purpose of
the briefings is to develop better understanding of the topical areas.
Outline for the briefing:

Everything that’s known about public opinion on the topic

What’s already in play in the area

Bringing all the information together in an efficient manner to
help sort through the subjects.

Presentation and time for discussion among the members.

Process for Deliberating on Potential Recommendations

Do we work at a subcommittee level before distributing to the wider
Working Group or ad hoc approach? For preparing for December and January;
agreement was that staff would develop briefing materials and consult
with interested individuals and then share for the entire group at the
meetings.